Health economic evaluations of non-pharmacological interventions for persons with dementia and their informal caregivers: a systematic review

Nickel, Florian T.; Barth, Janina; Kolominsky-Rabas, Peter

doi:10.1186/s12877-018-0751-1

Cited by 47 publications

(62 citation statements)

References 52 publications

(104 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additionally, total spending on home care for Medicare beneficiaries with Alzheimer's or other dementias nearly doubled between 2004 and 2011, although increases in spending may be due to a variety of factors, including more people being diagnosed with Alzheimer's dementia, more people using home care, an increase in the number of coexisting medical conditions, more intensive use of home care services and an increase in Medicaid coverage by older adults 207,549 . In two recent systematic reviews of the cost‐effectiveness of home support interventions for individuals with dementia, researchers found some evidence to support occupational therapy, home‐based exercise and some psychological and behavioral treatments as potentially cost‐effective approaches, although the research that has evaluated both the costs and benefits of home support interventions is scant 550,551 …”

Section: Use and Costs Of Health Care Long‐term Care And Hospicementioning

confidence: 99%

“…207,549 In two recent systematic reviews of the cost-effectiveness of home support interventions for individuals with dementia, researchers found some evidence to support occupational therapy, home-based exercise and some psychological and behavioral treatments as potentially cost-effective approaches, although the research that has evaluated both the costs and benefits of home support interventions is scant. 550,551 Transitions between care settings Individuals with dementia often move between a nursing facility, hospital and home, rather than remaining solely in a nursing facility. In a longitudinal study of primary care patients with dementia, researchers found that individuals discharged from a nursing facility were nearly equally as likely to be discharged home (39%) as discharged to a hospital (44%).…”

Section: Use and Costs Of Long-term Care Servicesmentioning

confidence: 99%

See 1 more Smart Citation

2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

1,953

653

View full text Add to dashboard Cite

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid‐century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.

show abstract

Section: Use and Costs Of Health Care Long‐term Care And Hospicementioning

confidence: 99%

Section: Use and Costs Of Long-term Care Servicesmentioning

confidence: 99%

2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

1,953

653

View full text Add to dashboard Cite

show abstract

“…Possible explanations for the inconsistencies can be the focus on different outcome parameters, sample sizes, or intervention periods. Additionally, many studies have adopted the narrower perspective of the health care and social system, instead of the comprehensive societal perspective [30]. Moreover, generalizability is restricted on account of different health care systems in other countries [30].…”

Section: Main Findings and Interpretationmentioning

confidence: 99%

“…Major strengths of our study are the randomized design and the relatively large sample size in comparison to former studies with similar designs [30,70,74].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…To date, mainly clinical effectiveness of non-pharmacological treatments for community-dwelling people with cognitive impairments and their caregivers was assessed (e.g., [14,16,19,25,27,28]). However, literature states that cost-effectiveness analyses focusing on evidencebased, structured, non-pharmacological treatments in the setting DCC for community-dwelling people with cognitive impairments continue to be limited [16,27,[29][30][31].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cost-effectiveness of a non-pharmacological treatment vs. “care as usual” in day care centers for community-dwelling older people with cognitive impairment: results from the German randomized controlled DeTaMAKS-trial

et al. 2020

View full text Add to dashboard Cite

Background Cognitive impairment in older adults causes a high economic and societal burden. This study assesses the costeffectiveness of the multicomponent, non-pharmacological MAKS treatment vs. "care as usual" in German day care centers (DCCs) for community-dwelling people with mild cognitive impairment (MCI) or mild to moderate dementia over 6 months. Methods The analysis was conducted from the societal perspective alongside the cluster-randomized controlled, multicenter, prospective DeTaMAKS-trial with waitlist group design. Outcomes were Mini-Mental Status Examination (MMSE) and Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM) of 433 individuals in 32 DCCs. Incremental differences in MMSE and ETAM were calculated via a Gaussian-distributed and incremental cost difference via a Gamma-distributed Generalized Linear Model. Cost-effectiveness was assessed via costeffectiveness planes and cost-effectiveness acceptability curves (CEAC). Results At 6 months, MMSE (adjusted mean difference = 0.92; 95% confidence interval (CI): 0.17 to 1.67; p = 0.02) and ETAM (adjusted mean difference = 1.00; CI: 0.14 to 1.85; p = 0.02) were significantly better in the intervention group. The adjusted cost difference was − €938.50 (CI: − 2733.65 to 763.13; p = 0.31). Given the CEAC, MAKS was cost-effective for 78.0% of MMSE and 77.4% for ETAM without a need for additional costs to payers. Conclusions MAKS is a cost-effective treatment to stabilize the ability to perform activities of daily living and cognitive abilities of people with MCI or mild to moderate dementia in German DCCs. Thus, MAKS should be implemented in DCCs.

show abstract

Economic Evaluation of Exercise or Cognitive and Social Enrichment Activities for Improved Cognition After Stroke

Adjetey,

Davis,

Falck

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceCognitive impairment is prevalent in survivors of stroke, affecting approximately 30% of individuals. Physical exercise and cognitive and social enrichment activities can enhance cognitive function in patients with chronic stroke, but their cost-effectiveness compared with a balance and tone program is uncertain.ObjectiveTo conduct a cost-effectiveness and cost-utility analysis of multicomponent exercise or cognitive and social enrichment activities compared with a balance and tone program.Design, Setting, and ParticipantsThis economic evaluation used a Canadian health care systems perspective and the Vitality study, a randomized clinical trial aimed at improving cognition after stroke with a 6-month intervention and a subsequent 6-month follow-up (ie, 12 months). The economic evaluation covered the duration of the Vitality trial, between June 6, 2014, and February 26, 2019. Participants were community-dwelling adults aged 55 years and older who experienced a stroke at least 12 months prior to study enrollment in the Vancouver metropolitan area, British Columbia, Canada. Data were analyzed from June 1, 2022, to March 31, 2023.InterventionsParticipants were randomly assigned to twice-weekly classes for 1 of the 3 groups: multicomponent exercise program, cognitive and social enrichment activities program, or a balance and tone program (control).Main Outcomes and MeasuresThe primary measures for the economic evaluation included cost-effectiveness (incremental costs per mean change in cognitive function, evaluated using the Alzheimer Disease Assessment Scale–Cognitive-Plus), cost-utility (incremental cost per quality-adjusted life-year gained), intervention costs, and health care costs. Since cognitive benefits 6 months after intervention cessation were not observed in the primary randomized clinical trial, an economic evaluation at 12 months was not performed.ResultsAmong 120 participants (mean [SD] age, 71 [9] years; 74 [62%] male), 34 were randomized to the multicomponent exercise program, 34 were randomized to the social and cognitive enrichment activities program, and 52 were randomized to the balance and tone control program. At the end of the 6-month intervention, the cost per mean change in Alzheimer Disease Assessment Scale–Cognitive-Plus score demonstrated that exercise was more effective and costlier compared with the control group in terms of cognitive improvement with an incremental cost-effectiveness ratio of CAD −$8823. The cost per quality-adjusted life-year gained for both interventions was negligible, with exercise less costly (mean [SD] incremental cost, CAD −$32 [$258]) and cognitive and social enrichment more costly than the control group (mean [SD] incremental cost, CAD $1018 [$378]). The balance and tone program had the lowest delivery cost (CAD $777), and the exercise group had the lowest health care resource utilization (mean [SD] $1261 [$1188]) per person.Conclusions and RelevanceThe findings of this economic evaluation suggest that exercise demonstrated potential for cost-effectiveness to improve cognitive function in older adults with chronic stroke during a 6-month intervention.

show abstract

Health economic evaluations of non-pharmacological interventions for persons with dementia and their informal caregivers: a systematic review

Cited by 47 publications

References 52 publications

2020 Alzheimer's disease facts and figures

2020 Alzheimer's disease facts and figures

Cost-effectiveness of a non-pharmacological treatment vs. “care as usual” in day care centers for community-dwelling older people with cognitive impairment: results from the German randomized controlled DeTaMAKS-trial

Economic Evaluation of Exercise or Cognitive and Social Enrichment Activities for Improved Cognition After Stroke

Contact Info

Product

Resources

About